Healthcare Provider Details

I. General information

NPI: 1457420135
Provider Name (Legal Business Name): CATARACT & LASER INSTITUTE P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PROSPECT ST STE 102
LAKEWOOD NJ
08701
US

IV. Provider business mailing address

101 PROSPECT ST STE 102
LAKEWOOD NJ
08701-5003
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-0699
  • Fax: 732-367-0937
Mailing address:
  • Phone: 732-367-0699
  • Fax: 732-367-0937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LEON S HUPPERT
Title or Position: DOCTOR
Credential: MD
Phone: 732-367-0699